RESUMEN
OBJECTIVE: Stress-only myocardial perfusion imaging protocol has a prognostic value similar to that of a stress-rest protocol. The aim of the study was to assess stress myocardial perfusion by gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (GSMPI) in patients who had a normal stress-only study 4.9 years (mean time) before and assess the possible influence of various factors on the results. SUBJECTS AND METHODS: Three hundred and forty patients who had a normal stress-only study in the past, were reexamined with GSMPI after a mean period of 4.9 years. RESULTS: Thirty out of 340 patients (8.8%) had an ischemic result on stress and were therefore submitted to a rest study. Differences between normal and pathological results across levels of potential prognostic factors (age, gender, diabetes mellitus, dyslipidemia, arterial hypertension, smoking and family history), symptoms,left ventricular ejection fraction (LVEF) on ultrasound (U/S), coronary angiography and pre-test probability did not prove statistically significant. On multivariable analysis patients with the combination of family history, diabetes mellitus and hypertension had a 10.7 times higher risk of a pathological scan than the patients without. DISCUSSION: The information delivered by stress-only GSMPI proved to be a prognostically reliable method for follow-up of low and intermediate pretest probability coronary artery disease (CAD) patients. CONCLUSION: The 91.2% of the patients with an initial normal stress-only GSMPI had a repeat normal stress-only GSMPI after a mean period of 4.9 years. The combination of family history, diabetes mellitus and hypertension increases the risk of a pathological scan significantly.
Asunto(s)
Enfermedad de la Arteria Coronaria , Imagen de Perfusión Miocárdica , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Prueba de Esfuerzo , Humanos , Perfusión , Pronóstico , Radiofármacos , Volumen Sistólico , Tomografía Computarizada de Emisión de Fotón Único , Función Ventricular IzquierdaRESUMEN
BACKGROUND: Acute myocardial infarction (AMI) is considered a major cause of death and disability. Myocardial perfusion scintigraphy (MPS) as a non-invasive diagnostic imaging procedure and certain biomarkers associated with myocardial ischemia (ISCH), such as ischemia-modified albumin (IMA), neuropeptide Y (NPY), N-terminal pro b-type natriuretic peptide (NT-proBNP), and high-sensitivity troponin T (hsTnT) could probably aid in the detection of myocardial infarction. METHODS: Between December 2011 and June 2012, we prospectively analyzed patients who underwent a MPS study with the clinical question of myocardial ISCH. An exercise test was performed along with a MPS. Blood was drawn from the patients before exercise and the within 3 minutes from achieving maximum load and was analyzed for the aforementioned biomarkers. RESULTS: A total of 71 patients (56 men and 15 women) were enrolled with a mean age of 61 ± 12 years. Twenty-six patients (36.6%) showed reduced uptake on stress MPS images that normalized at rest, a finding consistent with ISCH. Between ISCH and non-ISCH groups, only hsTnT levels showed a significant difference with the highest levels pertaining to the former group both before (0.0075 ng/ml vs 0.0050 ng/ml, P = 0.023) and after stress exercise (0.0085 vs 0.0050, P = 0.015). The most prominent differences were seen in higher stages of the Bruce protocol (stress duration > 9.05 minutes - P < 0.017). None of the IMA, NPY, and NP-pro BNP showed significant differences in time between the two groups. CONCLUSIONS: Although IMA, NPY, and NT-pro BNP may not detect minor ischemic myocardial insults, serum hsTnT holds a greater ability of detecting not only myocardial infarction but also less severe ischemia. Further studies with larger cohorts of patients are warranted in order to better define the role of hsTnT as a screening tool for myocardial ischemia.
Asunto(s)
Biomarcadores/sangre , Isquemia Miocárdica/diagnóstico por imagen , Troponina T/sangre , Anciano , Área Bajo la Curva , Ejercicio Físico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio , Péptido Natriurético Encefálico/sangre , Neuropéptido Y/sangre , Fragmentos de Péptidos/sangre , Probabilidad , Estudios Prospectivos , Sensibilidad y Especificidad , Albúmina Sérica HumanaRESUMEN
OBJECTIVES: The long-term effect of intracoronary infusion of progenitor cells in patients with chronic ischemic cardiomyopathy. BACKGROUND: Bone marrow stem-cell administration in patients with myocardial infarction improved myocardial performance and in some studies contributed to favorable left ventricular remodeling. METHODS: We report on the results of a pilot, single center, controlled safety, and feasibility study, including 24 patients with old, nonviable anterior myocardial infarction. Twelve patients underwent intracoronary administration of selected CD133(+) and CD133(-)CD34(+) progenitor cells and 12 were followed up on medical therapy. Left ventricular volumes and ejection fraction, at rest and during low-dose dobutamine, and myocardial viability, using TL-201 reinjection scintigraphy, were analyzed at baseline and long-term follow-up. RESULTS: Patients in the treatment group experienced a sustained decrease in left ventricular end-diastolic and end-systolic resting volumes (P = 0.008 and P = 0.002, respectively), as well as an improvement in global ejection fraction at rest [from (27.2 +/- 6.8)% to (29.7 +/- 7.3)%, P = 0.016]. Segmental anterior and apical wall perfusion, during TL-201 reinjection, were similarly improved (P = 0.005 and P < 0.001, respectively). One patient developed restenosis at the cell delivery site and one progression of atherosclerosis. During 28.0 +/- 8.7 months of clinical follow-up, only one patient experienced deterioration of heart failure. In the control group, we observed stability in the perfusion defect and deterioration in end-diastolic and end-systolic volumes (P= 0.002 and P = 0.003, respectively) and a nonsignificant decrease in ejection fraction (P = 0.11). CONCLUSION: Intracoronary infusion of selected CD133(+) and CD133(-)CD34(+) progenitor cells to a previously infarcted and nonviable anterior wall is safe, and results in sustained improvement in segmental myocardial perfusion and in favorable left ventricular remodeling.